1. Histology of the Skin Kelli A. Hutchens, MD, FCAP Director of Dermatopathology Assistant Professor Loyola University Medical Center Assistant Director of Mechanisms of Human Disease Loyola Stritch School of Medicine

2. Objectives Identify the epidermis, dermis, and subcutis of the skin Name and label the layers five layers of the of the epidermis Compare and contrast the anatomic and histologic differences between thick and thin skin Identify (when possible) / or know the location of the following cells: – Keratinocyte – Melanoycte – Merkel cell – Langerhan cell Describe the general function and location of the following components of the dermal epidermal junction and intercellular space. – Hemidesmosomes – Basement membrane – Basal layer keratinocytes – Anchoring fibrils – Desmosomes Name and identify the two regions of the dermis Identify and classify the following: – Eccrine gland – Sebaceous gland – Apocrine gland Compare and contrast the histologic appearance, function, and location of Pacinian corpuscles versus Meissner’s corpuscles.

3. Overview of the Skin Dermis Subcutis Epidermis

4. Most superficial layer of the skin Composed of multiple layers of keratin containing epithelial cells = keratinocytes with Melanocytes, merkel cells, and Langerhans dispersed throughout Major functions: – Maintenance of fluid and electrolyte balance – Protection from ultraviolet light – Sensory and immune function

5. Epidermis : Layers Cancel Lab Get Some Beer Stratum Corneum Stratum Granulosum Stratum Spinosum Stratum Basale Stratum Lucindum Stratum Lucidum Thin SkinThick Skin Rete ridge

6. Differences between thin & thick skin Thin Skin Palms of hands and soles of feet = acral skin 5 layers thick stratum corneum with increased granular layer More sensory receptors Lack sebaceous glands and increased eccrine glands No hair follicles Thick Skin Entire body except thick skin areas. Less than 5 layers of stratum corneum with no stratum lucidum Hair follicles present except lips, labia minora, and glans penis

7. Epidermis Desquamatization: – Layers of epidermis represent vertical maturation from undifferentiated basal cells to fully differentiated cornified cells – From basal cell to cornified cell takes about 25 days Shorter maturation periods seen in inflammatory conditions such as psoriasis Keratin production also changes as the cell matures and disruption in the mechanism can effect the integrity of the keratinocytes such as in Haily-Haily and Darier’s Disease.

8. Epidermis Basement Membrane Cell to Cell Adherence Zona adherens: Ca++ dependent cadherins that connect to actin Zona occludens: tight junctions prevent diffusion across cells Macula adherens: Made of desmosomes Gap junctions: communication for electric / metabolic function Hemidesmosomes: connect cells to BM

9. Epidermis Desmosome = Intercellular Bridges

10. Epidermis: Melanocytes Melanocytes: clearish cells in basal layer with dark nuclei ; ratio of 1: 10. Langerhans’s Cells: dendritic cells of the epidermis. Sit in the mid-spinous. Not visible by light microscopy. Merkel Cells: located in the stratum basale. Also not visible by light microscopy. They are receptor cells that establish synaptic contacts with sensory nerves and contain granules of neurotransmitters.

11. Dermal-Epidermal Junction Connects the epidermis and dermis It is composed of proteins which provide a firm connection – Hemidesmosome: connects basal keratinocytes to basement membrane – Basement membrane Lamina lucida = collagen types XVII, XIII, laminin 5 & 6 Lamina densa = collagen type VII – Anchoring fibrils attach the basement membrane to the dermis hooking on to collagen VII and collagen I.

12. Basement Membrane Lamina Lucida Lamina Densa Basal layer keratinocytes of epidermis Basement Membrane Hemidesmosomes Collagen type XVII, XIII Laminins 5 & 6 Collagen Type VII Anchoring Fibrils Dermis Collagen type I

13. Dermis Everything below the dermal epidermal junction / basement membrane – Connective tissue layer with contains blood vessels, nerves, sensory receptors, adnexal structures

14. Dermis – Two layers Papillary dermis = includes the dermal papilla which project into the epidermis – The increases contact area preventing epidermal detachment » Also results in an undulating pattern which vary by anatomic location and individual resulting in grooves in the epidermis =dermatoglyphics (fingerprints) – Capillaries, free nerve endings and encapsulated sensory receptors called Meissner’s corpuscles. Reticular dermis = area between the papillary dermis and subcutis

15. Papillary Dermis Capillaries

16. Dermis The dermis is composed of two major types of fibers: – Type I Collagen – Elastic fibers: three types based on microfiber and elastin content

17. Reticular Dermis Sebaceous Glands Erector Pili muscle Hair Follicle

18. Dermal Appendages Hair Follicle Pilar Muscle Sebaceous Glands Eccrine Glands

19. Sebaceous Glands Usually associated with hair follicles Simple branched acinar glands – Several acini that empty into single duct Holocrine secretion Empty “sebum” into hair follicle

20. Hair Follicle Outer Root Sheath Inner Root Sheath Hair Cuticle Hair Medulla Hair Cortex cross section (above the level of the bulb) Papilla Bulb Matrix Connective Tissue Sheath

21. Eccrine Glands Merocrine sweat glands Release to adjust body temperature Three cell types – Dark cells: pyramid shaped with secretory granules line lumen of tubule – Clear cells: located toward basement membrane – Myoepithelial cells: spindle shaped contractile cells

22. Apocrine Glands Apocrine glands – Similar to eccrine glands but larger lumens and ducts empty onto superficial regions of hair follicle – Release product by shedding of part of cytoplasm = apocrine snouting – Influenced by hormones (sexual scent glands) – Only found on axilla, areola, perianal and genital area

23. Subcutis Pacinian Corpuscle Subcutis – Area deep to the dermis – Includes the hypodermis Loose connective tissue containing adipose tissue, nerves, sensory receptors, arteries and veins Provides a flexible attachment to the underlying muscle and fascia Hair bulb in the subcutis of the scalp. Adipocytes